Specific clinical objectives of oxygen (O2) therapy include which of the following?
1.decrease the symptoms caused by chronic hypoxemia
2.decrease the workload hypoxemia imposes on the heart and lungs
3.correct documented arterial hypoxemia
D. 1, 2, and 3
Properly applied O2 therapy can decrease which of the following?
1.ventilatory demand
2.work of breathing
3.cardiac output
C. 1, 2, and 3
Benefits of properly applied O2 therapy in patients with chronic hypoxemia include all of the following except:
B. improved pulmonary using capacity
Which of the following would indicate a need for O2 therapy for an adult or child?
1.SaO2 less than 90%
2.PaCO2 greater than 45 mm Hg
3.PaO2 less than 60 mm Hg
C. 1 and 3
You start a chronic obstructive pulmonary disease (COPD) patient on a nasal O2 cannula at 2 L/min. What is the maximum time that should pass before assessing this patient’s PaO2 or SaO2?
C. 2 hours
According to ARC clinical practice guidelines, what is the minimum frequency for checking the functioning of an O2 delivery system?a.every 4 hours
b.every 8 hours
c.every 24 hours
d.every 48 hours
c.every 24 hours
You set up an Oxy-Hood with an FIO2 of 0.5 for a newborn infant. What is the maximum time that should pass before assessing this patient’s PaO2 or SaO2?
A. 1 hour
When determining a need for O2 therapy, the respiratory therapist should assess which of the following?
1.neurologic status
2.pulmonary status
3.cardiac status
A. 1, 2, and 3
Which of the following signs and symptoms are associated with the presence of hypoxemia?
1.tachypnea
2.tachycardia
3.cyanosis
4.bradycardia
A. 1, 2, and 3
What is/are the primary organ system(s) affected by O2 toxicity?
1.central nervous system (CNS)
2.lungs
3.kidneys
D. 1 and 3
Which of the following typically occurs first when monitoring the earliest physiologic response to breathing 100% O2?
B. substernal chest pain
A patient breathing 100% O2 for 24 hours or longer would most likely exhibit which of the following?
1.decreased DLCO
2.decreased CL
3.increased PAO2 – PaO2
4.decreased VC
C. 1, 2, 3, and 4
Which of the following is consistent with the radiographic appearance after prolonged exposure to O2?
B. patchy infiltrates
A physician places a patient in respiratory failure on 100% O2. To avoid the hazards of O2 toxicity, you would recommend that every effort be made to reduce this FIO2 to less than 50% within what time frame?
B. 5 day
A patient with chronic hypercapnia placed on an FIO2 of 0.6 starts hypoventilating. What is a possible cause of this phenomenon?
B. O2-induced hypoventilation
Retinopathy of prematurity (ROP) is a potentially serious management problem mainly in the care of whom?
D. premature or low-birth-weight infants
Some strategies for minimizing the risk of fire hazard with O2 therapy include all of the following, except:
D. mixing the oxygen with carbon dioxide.
To minimize the risk of retinopathy of prematurity (ROP), the American Academy of Pediatrics recommends keeping the PaO2 below what level?
D. 80 mm Hg
Which of the following is false about absorption atelectasis?
B. It can occur only when breathing supplemental O2.
Which of the following factors should be used in properly selecting an O2 delivery device?
1.knowledge of general performance of the device
2.physician’s preference
3.individual capabilities of the equipment
A. 1 and 3
To ensure a stable FIO2 under varying patient demands, what must an O2 delivery system do?
D. It must provide all the gas needed by the patient during inspiration.
Which of the following statements is false about low-flow O2 delivery systems?
B. The greater the patient’s inspiratory flow, the greater is the FIO2.
Delivery systems that provide only a portion of a patient’s inspired gas are referred to as what?
B. variable-performance systems
Low-flow O2 delivery systems used in respiratory care include all of the following except:
D. air-entrainment mask
A cooperative and alert post-op patient who is able to eat requires a continuous but low FIO2. Precise FIO2 concentrations are not needed. Which of the following devices would best achieve this end?
B. nasal cannula
Which of the following are advantages of the nasal cannula as a low-flow O2 delivery system?
1.stability
2.low cost
3.easy application
4.disposability
C. 2, 3, and 4
Which of the following is considered an advantage of the transtracheal catheter?
A. It requires 40% to 60% less O2 flow than the nasal cannula.
Some of the major disadvantages of the transtracheal catheter are all of the following, except:
B. excessive oxygen use
Which of the following factors will decrease the FIO2 delivered by a low-flow O2 system?
1.short inspiratory time
2.fast rate of breathing
3.lower O2 input
4.large minute ventilation
D. 1, 2, 3, and 4
A 27-year-old woman received from the emergency department is on a nasal cannula at 5 L/min. Approximately what FIO2 is this patient receiving?
A. 40%
You enter the room of a patient who is receiving nasal O2 through a bubble humidifier at 5 L/min. You immediately notice that the humidifier pressure relief is popping off. Which of the following actions would be most appropriate in this situation?
B. Look for crimped or twisted delivery tubing.
Which of the following is TRUE about reservoir cannulas?
C. Nasal anatomy and breathing pattern can affect performance of the device.
Disadvantages of standard O2 masks include all of the following except:
A. being difficult to apply to patients
Which of the following is FALSE about the simple O2 mask?
a.It has no valving system or reservoir bag.
b.It can easily deliver high FIO2 values (greater than 0.6 to 0.7)
c.It requires a minimal input flow of 5 L/min.
d.It generally functions as a variable-performance system.
b.It can easily deliver high FIO2 values (greater than 0.6 to 0.7)
A physician orders 2 L/min O2 through a simple mask to a 33-year-old postoperative woman with moderate hypoxemia breathing room air (PaO2 = 52 mm Hg). What would be the correct action at this time?
D. Recommend a flow of at least 5 L/min to wash out carbon dioxide (CO2).
What is the minimum flow setting for a simple mask applied to an adult?
C. 5 L/min
A 52-year-old man is admitted to the hospital emergency department with a primary complaint of severe radiating chest pain and signs of central cyanosis. The attending asks for your advice on selecting a device that provides a moderate FIO2 for this patient. Which of the following would you recommend?
D. simple O2 mask at 8 L/min
A physician orders supplemental O2 for a patient through a nasal cannula at a flow of 12 L/min. When you ask what the goal is, the physician states that the patient should receive about 60% O2. Which of the following should you recommend?
D. The O2 should be given through a simple mask set at 5 to 12 L/min.
A well-fitted nonrebreathing mask, adjusted so that the patient’s inhalation does not deflate the bag (flows approximately 10 L/min), should provide inspired O2 concentrations in what range?
C. 55% to 70%
You must deliver the highest possible FIO2 to a 67-year-old man with pulmonary edema breathing at a rate of 35/min. Which of the following O2 delivery systems would be most appropriate?
C. nonrebreathing mask at 12 to 15 L/min
A patient is receiving O2 through a nonrebreathing mask set at 8 L/min. You notice that the mask’s reservoir bag collapses completely before the end of each inspiration. Which of the following actions is appropriate in this case?
A. Increase the liter flow
A true high-flow O2 delivery system should provide at least what flow?
B. 60 L/min
Which of the following is FALSE about air-entrainment systems?
D. Their FIO2 values are directly proportional to their total flow.
Which of the following factors determine the actual O2 provided by an air-entrainment system?
1.O2 input flow to the jet
2.air-to-O2 ratio of the device
3.resistance downstream from the jet
A. 2 and 3
A patient receiving 35% O2 through an air-entrainment mask set at 6 L/min input flow becomes tachypneic. Simultaneously, you notice that the SpO2 has fallen from 91% to 87%. Which of the following actions would be most appropriate in this situation?
D. Increase the device’s input flow to 10 L/min.
You design an air-entrainment system that mixes air with O2 at a fixed ratio of 1:7 (1 L air to 7 L O2). About what O2 will this device provide?
A. 90%
A 45-year-old patient with congestive heart failure is receiving O2 through a 35% air-entrainment mask. With an O2 input of 6 L/min, what is the total output gas flow?
A. 36 L/min
You note that the air intake ports surrounding the jet of a 35% air-entrainment mask are partially obstructed by the patient’s bedding. Which of the following would you expect?
1.decrease in the device’s total output flow
2.increase in the percent O2 delivered by the device
3.change in the FIO2 received by the patient
C. 1 and 2
A physician orders 40% O2 through an air-entrainment nebulizer for a patient with a minute volume of 12 L/min. What is the minimum nebulizer input flow required to ensure the prescribed FIO2?
D. 10 L/min
You connect an intubated patient to an air-entrainment nebulizer system through a T-tube set at 60% with an input flow of 15 L/min. Toward the middle of inspiration, you observe that mist stops exiting from the open end of the T-tube. What does this indicate?
C. Patient is not receiving 60% O2.
What is the maximum FIO2 expected to be delivered by most air-entrainment masks?
A. 50%
Which of the following alternatives may increase the FIO2 capabilities of air-entrainment nebulizers?
1.Add open reservoir to expiratory side of T-tube.
2.Connect together two or more nebulizers.
3.Use a commercial dual-flow system.
4.Add open reservoir to inspiratory side of T-tube.
C. 1, 2, and 3
To ensure the prescribed FIO2 for a patient receiving 65% O2, you apply a closed reservoir delivery system with a one-way expiratory valve. What other component must be included in this system to ensure a fail-safe operation?
C. emergency inlet valve
An O2 delivery device takes separate pressurized air and O2 sources as input, then mixes these gases through a precision valve. What does this describe?
C. O2 blending system
A physician requests that you provide a patient with exactly 45% O2 at a flow of 60 L/min. Lacking a blender, you must manually mix air and O2 to achieve the desired mixture at the prescribed flow. Which of the following air and O2 flows would you select?
Air (L/min) O2 (L/min)
D. 42 18
Which of the following are components of a typical O2 blender?
1.precision metering device or mixture control
2.audible dual low-pressure alarm system 3.pressure regulating and equalizing 4.valves variable-size air-entrainment port
C. 1, 2, and 3
To confirm proper operation of an O2 blending system, what should you do?
1.Test low-pressure alarms and bypass systems.
2.Analyze FIO2 at 0.21, 1.00, and prescribed level.
3.Confirm air and O2 inlet pressures.
D. 1, 2, and 3
What is the upper limit of O2 concentrations available through tents?
C. 40% to 50%
A physician wants a stable FIO2 of 0.5 for a newborn infant with severe hypoxemia. Which of the following systems would you select?
C. O2 hood with blender and heated humidifier
What is the problem with input flows greater than 10 to 15 L/min in an infant Oxy-Hood?
B. production of harmful noise levels
In giving O2 to an infant through a hood, which of the following is/are correct?
1.neutral thermal environment should be maintained.
2. Gases should be directed away from the infant’s face. 3.High input flow (greater than 10 to 15 L/min) should be avoided.
4.A minimum flow of 7 L/min must be maintained
A. 1, 2, 3, and 4
Directing a cool O2 mixture to an infant in an Oxy-Hood can result in which of the following?
1.increased O2 consumption 2.increased convective heat loss
3.apnea (cessation of breathing)
D. 1, 2, and 3
What temperature is required to maintain a neutral thermal environment (NTE) in an Oxy-Hood for infants weighing 2500 g or more?
B. 35° C
An infant requires both a precise high FIO2 and maintenance of a neutral thermal environment. Which of the following systems can best achieve these goals?
1.Oxy-Hood or warmed O2 blending system without incubator
2.heated incubator with automatic O2 controlling system
3.heated incubator with Oxy-Hood or O2 blending system
B. 1 and 2
A variant of a common low-flow, nasal O2 delivery device which is capable of providing both high humidity and a high FIO2 is known as which of the following?
A. high-flow nasal cannula
What are some key patient considerations in selecting O2 therapy equipment?
1.type of airway (natural or artificial)
2.severity and cause of the hypoxemia
3.age group (infant, child, adult)
4.stability of the minute ventilation
D. 1, 2, 3, and 4
In which of the following clinical situations would you recommend hyperbaric oxygen (HBO) therapy, if available?
1.carbon monoxide poisoning
2.respiratory or cardiac arrest
3.severe trauma
4.cyanide poisoning
D. 1 and 4
Which of the following would indicate adequate oxygenation for adult patients with chronic lung disease and an accompanying acute-on-chronic hypoxemia?
1.SaO2 of 90% or higher 2.PaO2 of 50 mm Hg to 60 mm Hg
3.SaO2 of 85% to 90%
B. 2 and 3
A patient receiving 3 L/min O2 through a nasal cannula has a measured SpO2 of 93% and no clinical signs of hypoxemia. At this point, what should you recommend?
A. decreasing the flow to 2 L/min and rechecking the SpO2
What is the level of SpO2 typically associated with discontinuation of O2 therapy?
C. 92%
What does 1 atmospheric pressure absolute (ATA) equal?
1.101 kPa
2.50 psi
3.760 mm Hg
B. 1 and 3
Physiologic effects of hyperbaric oxygen (HBO) therapy include all of the following except:
A. systemic vasodilation
During hyperbaric oxygen therapy at 3 ATA, plasma contains about how much dissolved O2?
C. 7 ml/dl
Which of the following is false about multiplace hyperbaric oxygenation chambers?
D. The chamber normally is filled with 100% O2.
All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy except:
C. septic shock
In which of the following procedures is air embolism a potential complication?
1.central line placement
2.lung biopsy 3.hemodialysis
C. 1, 2, and 3
At an FIO2 of 1, what is the approximate half-life of blood carboxyhemoglobin?
D. 80 minutes
During hyperbaric oxygen (HBO) therapy at 3 ATA, what is the approximate half-life of blood carboxyhemoglobin?
D. 23 minutes
Criteria for initiating hyperbaric oxygen (HBO) therapy on an adult patient suspected of suffering from acute carbon monoxide poisoning include all of the following except:
C. history of unconsciousness
At what level of carboxyhemoglobin saturation is hyperbaric oxygen (HBO) therapy indicated for an adult patient?
D. greater than 25%
Primary safety concerns in the application of hyperbaric oxygenation include which of the following?
1.sudden decompression 2.electrical fires
3.CO2 accumulation
D. 1 and 2
What is the most common complication of hyperbaric oxygen therapy?
C. ear or sinus barotrauma
Physiologic effects of inhaled nitric oxide (NO) include all of the following except:
A. recruitment of collapsed alveoli
Potential uses for inhaled NO include all of the following except:
A. status asthmaticus
What is the recommended maximum initial dose of inhaled NO in neonates with respiratory distress syndrome?
A. 20 ppm
Toxic side effects of inhaled NO include all of the following except:
C. sulfhemoglobinemia
Which of the following is FALSE about NO2?
a.NO2 levels greater than 10 ppm can cause hemorrhage, pulmonary edema, and death.
b.NO2 is produced spontaneously whenever NO is exposed to O2
.c.The Occupational Safety and Health Administration (OSHA) safety limit for NO2 exposure is 5 ppm.
d.NO2 exposure should be kept below 5 ppm during NO administration.
d.NO2 exposure should be kept below 5 ppm during NO administration.
Potential adverse effects associated with NO therapy include all of the following except:
D. increased blood clotting
Features of an ideal delivery system for NO for use with mechanical ventilation include all of the following except:
D. premixes NO and O2 in a holding reservoir
To prevent an adverse rebound effect when withdrawing NO therapy, what should you do?
1.Reduce the NO to the lowest effective dose (ideally, less than 5 ppm). 2.Hyperoxygenate the patient just before discontinuing NO.
3.Ensure that the patient is hemodynamically stable.
D. 1, 2, and 3
Which of the following is an indication for the use of helium-O2 mixtures?
A. large-airway obstruction
Compared to air, the density of an 80% He and 20% O2 mixture is about which of the following?
A. one-third as much
. A physician orders a 70% He:30% O2 mixture to reduce the work of breathing in a patient having an acute asthmatic attack. Which of the following delivery systems would be appropriate in this case?
A. nonrebreathing mask at 10 L/min
You are giving a 80% He:20% O2 mixture to an asthmatic patient through a nonrebreathing mask with a compensated Thorpe tube O2 flowmeter set at 8 L/min. What is the actual flow being delivered to the patient?
B. 14 L/min
Before administering a helium-O2 mixture to a patient with large airway obstruction, what should you do?
D. Analyze the O2 concentration of the mixture.
Mixtures of carbon dioxide and oxygen in blends of 5% : 95% or 7% : 93%, which are occasionally used to prevent complete washout of carbon dioxide during cardiopulmonary bypass or treat hiccoughs is known as which of the following?
